A Tale of Two Prostheses
Prosthetics are amazing. Aimee Mullins and Oscar Pistorius are living examples of how a disability can become an opportunity not just for success, but for super-human ability. Our popular culture is packed with characters with enabling prostheses: Lt. Dan, Luke Skywalker, and Nina Sharp. Within the past decade, many have come to the realization that a prosthetic need not be a disturbing hook or peg leg. It need not be an impediment or an indicator of dysfunction. In fact, it can be a thing of beauty.
But there is a problem: cutting-edge prostheses are absurdly expensive. Fast Company has a great article on Hugo Herr, an M.I.T. professor, and Carrie Davis (pictured), both of whom have incredible, powerful prostheses. As I was coming down from my techno-fetish high after reading the article, I noticed the comments. They offered quite a different picture, pointing out the cost, first and foremost, as well as the rose-colored glasses the author and his interviewees seems to be wearing. One commenter wrote:
While Carrie may have a cool iLimb that makes a noise when she touches her wine glass — I would like to know what Carrie thinks when she wants to do something as simple as scratch her ass, or change her tampon, or touch her babies face.
The point is the prosthetics are still imperfect. The commenters note the failure rate of the technology, the problems of putting on the prosthetic itself, and the lack of options for many amputees. Their points are valid, but sadly both commenters veer in the opposite direction of the article, coming off as cynical and morose about the condition of those who need prostheses. Both the commenters and Hugo Herr discuss eyeglasses as a kind of prosthetic. The point Herr makes is that eyeglasses are so common that, in addition to being functional, many people incorporate them into their fashion sense. In fact, when given the option to wear contacts, get Lasik, or wear glasses, many still choose glasses. I am one of those people, but I believe Herr is over simplifying. Contacts dry out when you’re on the computer a lot (like me) and Lasik is only worth while to those with a very bad prescription (unlike me). Glasses, in addition to making me look rather dashing, are just the most functional of my options. But, and this is the important part, I have options. The problem with the limbs described by the Fast Company article is that they are a combination of Lasik and fashion glasses: expensive, top-of-the-line, and unnecessary for most people.
Which is where we come to the other side of the story. The carbon-fiber showpiece Carrie Davis adorns with a Tiffany ring and holds a wine glass is about as far from the Jaipur foot as one can get:
The beauty of the Jaipur foot is its lightness and mobility–those who wear it can run, climb trees and pedal bicycles–and its low price. While a prosthesis for a similar level of amputation can cost several thousand dollars in the U.S., the Jaipur foot costs only $28 in India. Sublimely low-tech, it is made of rubber (mostly), wood and aluminum and can be assembled with local materials. In Afghanistan craftsmen hammer the foot together out of spent artillery shells. In Cambodia, where roughly 1 out of every 380 people is a war amputee, part of the foot’s rubber components are scavenged from truck tires.
That is innovation of the best kind. The Jaipur foot was developed by Dr. Pramod Karen Sethi and Ram Chandra. The former is an orthopedic surgeon and member of the Royal College of Surgeons, the other, an artisan with barely an elementary school education. Their story is beautifully chronicled in Time‘s “Heroes of Medicine” series. The Jaipur foot allows mobility, comfort, and is, thanks to Chandra’s skills, beautiful.
One one end of the spectrum, we have the hyper-expensive, power-assist, high-tech PowerFootOne by Hugo Herr, and on the other end, the Jaipur foot, $28 and made of recycled artillery shells and tires. So who is right? Is Herr right in trying to develop a foot that does more than any other prosthetic foot, pushing the limits of tech a little further out? Or are Sethi and Chandra right, to build a minimally expensive foot that restores basic function to those who need it? Are the commenters right, in pointing out the ridiculous attitude Herr and Davis have in regarding their prosthetics as positive, beautiful aspects of their selves? Which do we choose?
All three. The points and purposes are not mutually exclusive. The commenters, who represent skeptics at large, keep the tech and prosthetics developers honest: hooray, you’ve built a fancy, expensive, fashion piece that breaks easily and is only affordable to those in the highest tax brackets. Skeptics are the ones who turn our heads from the shiny show pieces to the practical inventions, like those of Sethi and Chandra. Yet there is no reason that the inventions of Herr (and of others, like Dean Kamen’s Luke Arm or the Cheetah Blades used by Aimee Mullins) cannot exist in the same world as the Jaipur foot. Let wealthy socialites like Carrie Davis wear a Tiffany ring on her liquid-black, high-fashion arm. In doing so, let her turn banal cocktail conversation towards the better purpose of normalizing prosthetics. If she can afford a “bag of hands worth more than [her] house,” good for her! It seems she is using that wealth to force the wealthy gaze onto the issue of prosthetics. Herr and Davis are on the same side as Sethi and Chandra; all are working to improve the lives and well-being of those with a need for prostheses.
For a farmer in India, the Jaipur foot lets daily life return to about normal, at least enough to keep bringing in the crops. For Davis, an arm that costs as much as a luxury sedan lets her mingle in high-society, get noticed, and come off as superior. The Jaipur foot sends the message, “If you have lost a limb, all is not lost. There is hope.” The work of Herr, Mullins, Davis and Pistorius says, “Just because I have a prosthetic does not mean I am disabled. In fact, I may be better off than you. I might be enhanced.” The combined message of both groups is, “A lost limb need not be permanent, disfiguring, or disabling. It is a common, real problem and it is one we can solve. And in that solution, there may be a better, empowering, improvement on what nature originally gave us.”
Tags: BP, Medicine, Prosthetics
Pop Transhumanism | Kyle Munkittrick | 
February 3, 2010 10:38 am
By Jonathan Kuniholm, February 3, 2010 @ 12:54 pm
Unfortunately, prosthetics really are not as amazing as a lot of these articles would have you believe. Please see my own response to the Fast Company article: http://openprosthetics.ning.com/profiles/blogs/the-six-million-dollar-meme
The reality of the advanced prosthetic arm in the pic above (if my own experience as a user and researcher is a guide) is that Carrie probably cannot actually drink the wine from the glass she is holding with her prosthetic arm. Indeed, the suspension method shown likely limits her arm flexion to the 90 degrees that she is shown with in the picture. Further, the wrist does not flex (it does turn), and the wrist movement is not reliable enough to coordinate drinking. If she is going to drink that wine, I’d guarantee she’ll be using her other hand.
This was my own point: at least as far as arms are concerned, the promise of human ability (much less superhuman ability) is not one that we’re going to make good on anytime soon.
As I stated in my other comments, while I think that it is important to celebrate the actual achievements of rehabilitation engineers, if we continue to celebrate achievements that have not actually come to pass, it will eventually become difficult to raise money to solve problems we’ve already taken a victory lap for.
So I’ll definitely come down on the “gloom and doom” side. This is only necessary, however, because reality has been conspicuously absent from this discussion in both the popular and academic press. We can do much better, both in the lab, and when we write about the lab.
Jon Kuniholm
By Kyle Munkittrick, February 4, 2010 @ 11:09 am
Jon, I agree with you in that the Fast Company article, in addition to many others, was overly optimistic and didn’t highlight problems. I also agree that real, practical achievements should be highlighted, hence my discussion of the Jaipur foot.
My primary concern here is that the high-profile, high fashion prostheses are designed to draw attention in the way purely functional ones do not. There is something of a reverse-discourse effect with Herr and Davis’ prostheses, challenging the observer. It is in that challenge, and the rejection of the “oh how sad, that person has a “fake” arm or leg” that I see the benefit.
The Jaipur foot is more important for real-world need, the high-fashion arm more important for social and normative change. They are mutually beneficial.